Dunlay Shannon M, Sangaralingham Lindsey R, Lampman Michelle A, Ziegelbauer Lorelle L, Smith Jamie L, Kall Mikaela M, Kinnucan Jami A, Farris Keavy J, Mattson Josh L, Storino Colleen B, Loftus Conor G
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (S.M.D.).
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (L.R.S., M.A.L., L.L.Z., J.L.S., M.M.K.).
Ann Intern Med. 2025 Jan;178(1):11-19. doi: 10.7326/ANNALS-24-01711. Epub 2024 Dec 31.
Patient-provider communication through the patient portal has markedly increased in recent years. Some health care facilities implemented programs to enable providers to bill for responding to patient-initiated messages that require substantive medical decision making through an e-visit.
To evaluate the effect of billing eligible patient-initiated portal messages as e-visits using a mixed-methods approach.
Retrospective observational pre-post comparison and prospective survey.
Large integrated health system with sites in 4 U.S. states.
Patients initiating portal message threads and health system providers completing an online survey.
E-visit billing was implemented 18 August 2023.
The volume of patient-initiated medical advice message threads pre- versus postimplementation of e-visit billing was compared. Health system provider perceptions of e-visit billing were assessed using an online survey.
In the 6 months after e-visit billing implementation (18 August 2023 through 18 February 2024), the volume of patient-initiated medical advice message threads decreased by 8.8% (from 1 813 818 to 1 653 708) compared with the same dates the year prior ( = 0.002). A total of 5183 (0.3%) medical advice messages were billed. There was no difference in 7-day use of emergency services (emergency department visits or hospitalizations) in patients who proceeded with sending a message versus those that did not send a message after viewing the billing disclaimer on the patient portal. Providers reported overall acceptance of e-visit billing but expressed concerns about increased workload with the current process.
Cannot assess changes in other forms of contact, including telephone calls.
These findings suggest that implementation of e-visit billing was associated with a modest decrease in patient-initiated portal message volume and was overall acceptable to providers in a large integrated health system.
None.
近年来，患者通过患者门户网站与医疗服务提供者之间的沟通显著增加。一些医疗机构实施了相关项目，使医疗服务提供者能够就通过电子问诊对患者发起的需要进行实质性医疗决策的信息进行回复而计费。
采用混合方法评估将符合条件的患者发起的门户网站信息计为电子问诊的效果。
回顾性观察前后对比及前瞻性调查。
在美国4个州设有站点的大型综合医疗系统。
发起门户网站信息线程的患者以及完成在线调查的医疗系统提供者。
2023年8月18日实施电子问诊计费。
比较电子问诊计费实施前后患者发起的医疗咨询信息线程数量。通过在线调查评估医疗系统提供者对电子问诊计费的看法。
在电子问诊计费实施后的6个月内（2023年8月18日至2024年2月18日），患者发起的医疗咨询信息线程数量与上一年同期相比减少了8.8%（从1813818条降至1653708条）（P = 0.002）。共有5183条（0.3%）医疗咨询信息被计费。在患者门户网站上查看计费免责声明后继续发送信息的患者与未发送信息的患者在7天内使用紧急服务（急诊就诊或住院）方面没有差异。提供者报告总体上接受电子问诊计费，但对当前流程增加工作量表示担忧。
无法评估包括电话在内的其他联系方式的变化。
这些发现表明，电子问诊计费的实施与患者发起的门户网站信息数量适度减少有关，并且在大型综合医疗系统中总体上为提供者所接受。
无。
